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Hepatomegaly: causes, signs, treatment

by Josephine Andrews
Published: Last Updated on 386 views

Hepatomegaly means liver enlargement. The different parts of the liver can be enlarged evenly or unevenly, which is referred to as harmonious or disharmonious hepatomegaly. Liver disease is often the cause of organ enlargement. Sometimes there are also diseases of other body organs. Read more about the causes, signs and treatment of hepatomegaly here.

Hepatomegaly: description

The term hepatomegaly means nothing more than liver enlargement. The liver is a wedge-shaped, two-lobed organ located mostly in the right upper abdomen just below the diaphragm. It is the central metabolic organ and, at around 1.5 kilograms, the largest gland in the body.

If the liver is abnormally enlarged, it is usually a fatty liver. Rarely, other diseases are the cause of hepatomegaly. In many cases, in addition to the liver enlargement, there is also an enlargement of the spleen at the same time. Doctors then speak of hepatosplenomegaly.

Hepatomegaly: causes and possible diseases

Hepatomegaly can occur as a side effect of a wide variety of diseases. The most common reason for liver enlargement is fatty liver. But other liver diseases and diseases of other organs can also cause hepatomegaly:

Metabolic or toxic liver diseases

The liver reacts to a wide variety of harmful influences by becoming fatty, such as chronic alcohol consumption, overeating (obesity), viral or metabolic diseases (such as diabetes mellitus or increased blood lipid levels) and certain medications and chemicals. However, doctors only speak of a fatty liver when fat is stored in more than half of all liver cells. If fewer cells are fatty, this is called fatty liver. The heavy accumulation of fat leads to liver enlargement.

Other metabolic or toxin-related liver diseases that can lead to hepatomegaly are storage diseases (such as the iron storage disease haemochromatosis) and certain forms of the metabolic disease porphyria. Liver involvement with subsequent hepatomegaly can also occur in the context of other metabolic diseases and hormonal diseases.

Inflammatory liver diseases

Inflammatory liver disease is another possible cause of hepatomegaly. The inflammation can be caused by viruses , an incorrect reaction of the immune system (autoimmune disease), alcohol or toxins. Examples of inflammatory liver diseases that can be associated with hepatomegaly are acute or chronic liver inflammation (hepatitis), liver cirrhosis and liver granulomas. Granulomas are inflammation-related, nodular tissue growths. They arise, for example, in the context of tuberculosis, AIDS or sarcoid .

Diseases with bile stasis

Diseases associated with obstruction of the flow of bile (cholestatic diseases) can also result in hepatomegaly.

Bile is made in the liver and secreted to the small intestine (using the gallbladder as a temporary storage facility) to aid in the digestion of fat . A build-up of bile can lead to liver enlargement. The cause of congestion can be inside or outside the liver. Examples of cholestatic diseases with possible hepatomegaly are bile duct obstruction (e.g. due to gallstones), primary biliary cirrhosis and bile stasis due to medication or during pregnancy.

Blood vessel diseases

Sometimes hepatomegaly is caused by a disease affecting the blood vessels (vascular). An example of this is right heart failure (right heart failure): Here the right ventricle is no longer able to pump the venous blood coming from the body into the pulmonary circulation. As a result, the venous blood backs up, which, in addition to congested neck veins, can also lead to liver congestion with liver enlargement. Venous blood can also back up into the liver if there is a faulty heart valve between the right atrium and right ventricle (tricuspid valve defect) or if there is a “shell heart” (constrictive pericarditis).

Other vascular diseases that can result in hepatomegaly include (in)complete occlusion of the large hepatic veins (Budd-Chiari syndrome), occlusion of the inferior vena cava caused by a clot ( inferior vena cava thrombosis) and an occlusion or a Bulging (aneurysm) of the hepatic artery.

infections

Infections with various pathogens are also among the possible causes of hepatomegaly. For example, inflammation of the bile ducts (cholangitis), liver abscesses, and parasitic liver diseases (such as hydatid disease or schistosomiasis) can cause liver enlargement. In addition, hepatomegaly can also turn out to be a reactive liver change in infectious diseases.

Cystic liver and liver cysts

Liver cysts are smooth, fluid-filled cavities in the liver, ranging in size from a few millimeters to more than ten centimetres. They can occur singly or in groups. If the liver is interspersed with cysts , it is referred to as a cyst liver. In the case of very large cysts and a cystic liver, liver enlargement can result.

tumors

In some cases, benign or malignant liver tumors are the reason for hepatomegaly. In addition, malignant tumors in other parts of the body (such as colon, stomach or breast cancer) can form secondary ulcers in the liver ( liver metastases ) and thus lead to liver enlargement.

Hepatomegaly: when should you see a doctor?

If you feel pressure and/or pain in the upper abdomen – possibly accompanied by other symptoms – you should see a doctor for clarification. Hepatomegaly may be behind it.

Hepatomegaly: what does the doctor do?

First, the doctor collects the medical history (anamnesis): He asks you in detail about your symptoms, possible previous illnesses (such as hepatitis, tumors) and possible underlying diseases (dyslipidemia, diabetes, gallstones, etc.). Information about your alcohol and medication consumption, (foreign) trips in the past and any weight loss are also important for clarifying hepatomegaly. Various examinations follow the interview.

Physical examination

The doctor feels the abdomen (palpation) to estimate the size of the liver and to get possible clues about the cause of the hepatomegaly. For example, in hepatitis and congestive liver, the liver feels soft and smooth and may be painful when pressure is applied. On the other hand, a hard, irregular to bumpy liver, for example, indicates liver cirrhosis or liver cancer as a possible cause of hepatomegaly.

The doctor also examines the size of the spleen by palpation . Because hepatomegaly (enlarged liver) sometimes goes hand in hand with splenomegaly (enlarged spleen) – together then called hepatosplenomegaly.

The doctor also examines the skin for signs of jaundice (icterus) or the iron storage disease hemochromatosis (possibly dark skin pigmentation). So-called liver skin signs are also revealing, i.e. characteristic skin changes in chronic liver diseases (such as liver cirrhosis). These include, for example, spider nevi (visible enlargement of skin arteries reminiscent of spider legs) and reddened palms (palm erythema).

Other physical signs also provide clues to the cause of hepatomegaly. For example, swollen legs (leg edema) and congested neck veins indicate right heart failure.

blood tests

If the physical examination confirms hepatomegaly, a blood test is performed. For example, the differential blood count, the erythrocyte sedimentation rate (ESR), various liver enzymes, the iron and cholesterol levels and blood coagulation (Quick value/INR) are determined.

If the hepatomegaly is accompanied by an enlarged spleen (hepatosplenomegaly), the doctor may order other blood tests (such as the Coombs test to check for antibodies to red blood cells).

Imaging procedures

An ultrasound examination of the abdomen ( abdominal sonography ) is also part of the routine when clarifying hepatomegaly. The doctor examines the liver, spleen, bile ducts and the portal vein system (venous vascular system, which carries the blood from the stomach, intestines and spleen via the portal vein first to the liver and then on to the inferior vena cava).

A chest X-ray can provide further clues as to the cause of the hepatomegaly. An enlarged heart and a pleural effusion can be consequences of right heart failure. (Malignant) swollen lymph nodes (lymphomas) can also be seen on the X-ray.

Further investigations

If the doctor suspects certain diseases to be the reason for the hepatomegaly, further diagnostic steps may be necessary. For example, if a certain form of tuberculosis (miliary tuberculosis) or sarcoidosis is suspected as the cause of liver enlargement, it may be necessary to take a tissue sample from the liver (liver puncture).

This is how the doctor treats hepatomegaly

Since liver enlargement is a side effect of a wide variety of diseases, it is important to treat it. For example, in the case of the most common cause of hepatomegaly, fatty liver, the underlying disease must be treated or lifestyle changes must be made. This is the only way to ultimately eliminate hepatomegaly.

Hepetomeglie: You can do this yourself

In most cases, fatty liver is behind hepatomegaly. At some point, this can turn into dangerous, irreversible cirrhosis. But there are things you can do to keep your liver healthy. A healthy lifestyle is crucial, because too much alcohol, too much and too fatty food, obesity and lack of exercise put a strain on the organ.

Appropriate vaccinations also protect against hepatitis. Also, have your liver values ​​checked regularly so that you can take action in good time if your liver suffers. Then there is no hepatomegaly in the first place .

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